• Journal of Trauma and Injury
• /
• 제33권4호
• /
• pp.269-274
• /
• 2020

Open pelvic fractures are rare, but pose challenges for trauma surgeons due to their high morbidity and mortality. Generally, early death results from uncontrolled exsanguination and late death is related to pelvic sepsis. Therefore, management of these injuries should prioritize hemostasis and contamination control starting in the initial phase of treatment. We report two cases of unstable open pelvic fractures with perineal wounds that were managed successfully.

• Journal of Trauma and Injury
• /
• 제34권2호
• /
• pp.98-104
• /
• 2021

Purpose: Severe pelvic fractures are associated with genitourinary injuries, but the relationship between pelvic trauma and concomitant urethral injuries has yet to be elucidated. This study evaluated the incidence, mechanism, site, and extent of urethral injuries in male patients with pelvic fractures. Methods: A retrospective cohort study was performed involving patients with urethral injuries accompanying pelvic fractures who visited Pusan National University Hospital from January 1, 2014 to December 31, 2019. Demographics, mechanisms of injury, clinical features of the urethral injuries, concomitant bladder injuries, methods of management, and the configuration of the pelvic fractures were analyzed. Results: The final study population included 24 patients. The overall incidence of urethral injury with pelvic fracture was 2.6%, with the most common mechanism of urethral injury being traffic accidents (62.5%). Complete urethral disruption (16/24, 66.7%) was more common than partial urethral injuries (8/24, 33.3%), and unstable pelvic fractures were the most common type of pelvic fracture observed (70.8%). There was no definitive relationship between the extent of urethral injury and pelvic ring stability. Conclusions: The present study provides a 6-year retrospective review characterizing the incidence, mechanism, and clinical features of urethral injury-associated pelvic fractures. This study suggests that the possibility of urethral injury must be considered, especially in unstable pelvic fracture patients, and that treatment should be chosen based on the clinical findings.

• Journal of Trauma and Injury
• /
• 제22권2호
• /
• pp.254-259
• /
• 2009

Purpose: Pelvic trauma is a serious skeletal injury with high mortality. Especially in cases of severe injury trauma, treatment outcomes depend on early diagnosis and intervention. We expect trauma surgeon to play an important role in the management of severe multiple trauma patients. Methods: A retrospective study was performed on pelvic trauma patients with hemodynamic instability between March 2005 and September 2009. We divided the time period into period I (March 2005~Feburary 2009) and period II (March 2009~September 2009). The trauma surgeon and team started to work from period II. Data were collected regarding demographic characteristics, mechanism of injury, type of pelvic fracture, ISS(injury severity score), treatment modality, transfusion requirement, time to definitive treatment, and mortality. Results: During period I, among 7 hemodynamically unstable patients, 4(57.1%) patients died. However during Period II, only one of 6(16.6%) patients died. The demographic data and injury scores showed no differences between the two time periods, but the time to definitive treatment was very short with trauma team intervention(14.4 hrs vs. 3.9 hrs). Also, the amount of transfusion was less(41.1 U vs. 13.9 U). With arterial embolization, early pelvic external fixation led to less transfusion and made patients more stable. Conclusion: This study demonstrated the importance of the trauma surgeon and the trauma team in cases of hemodynamically unstable pelvic trauma. Even with the same facility and resources, an active trauma team approach can increase the survival of severely injured multiple trauma patients.

• Journal of Trauma and Injury
• /
• 제27권4호
• /
• pp.224-228
• /
• 2014

Pelvic ring and acetabular fractures are major high-energy trauma injuries and are often associated with other injuries or fractures. In particular, a venous thromboembolism is an important common complication in trauma patients with pelvic or acetabular fractures. We report a case of a fatal pulmonary thromboembolism after a pelvic fracture in a 60-year-old female patient.

• Journal of Trauma and Injury
• /
• 제29권4호
• /
• pp.161-166
• /
• 2016

Purpose: Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography. Methods: This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015. Results: Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%). Conclusion: The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.

• 대한영상의학회지
• /
• 제84권4호
• /
• pp.835-845
• /
• 2023

골반 외상은 대부분 고에너지 손상을 동반하며, 이에 따른 치명률 및 사망률이 높은 편이다. 관련된 출혈은 대부분 골반내 정맥이 손상되거나 해면골이 골절되어 발생하고 혈종에 의해 안정화되지만, 10%-20%에서 동맥 출혈이 동반되며, 골반 용적이 증가된 상태에서 동맥 출혈이 지속된다면 이로 인한 사망률은 36%-54%까지 증가한다. 골반의 해부학적 구조상 다양하고 풍부한 혈관이 분포되어 있고, 골반 외상 환자 대부분이 많은 양의 혈종을 동반하기 때문에, 수술적 치료는 시야 확보의 어려움과 눌림 효과에 따른 지혈효과를 없애 출혈을 더 조장할 수 있어, 1차적으로 인터벤션 치료가 권고되고 있다. 또한 출혈의 위치가 대부분 골절된 부분이기 때문에 CT를 통해 시술 전 출혈 부위를 특정하여 빠른 시간 내에 출혈에 대한 색전술을 시행할 수 있다. 이처럼 올바른 진단과 치료를 동시에 할 수 있다는 장점으로 인해 골반 외상 환자에 있어 인터벤션 치료는 중추적인 역할을 담당하고 있다. 본 연구에서는 문헌고찰을 통해 골반 외상에 대한 올바른 진단 및 인터벤션 치료의 유용성과 고려 사항에 대해 알아보고자 한다.

• Journal of Trauma and Injury
• /
• 제37권1호
• /
• pp.6-12
• /
• 2024

Purpose: Open pelvic bone fractures are relatively rare and are considered more severe than closed fractures. This study aimed to compare the clinical outcomes of open and closed severe pelvic bone fractures. Methods: Patients with severe pelvic bone fractures (pelvic Abbreviated Injury Scale score, ≥4) admitted at a single level I trauma center between 2016 and 2020 were retrospectively analyzed. Patients aged <16 years and those with incomplete medical records were excluded from the study. The patients were divided into open and closed fracture groups, and their demographics, treatment, and clinical outcomes were compared before and after 1:2 propensity score matching. Results: Of the 321 patients, 24 were in the open fracture group and 297 were in the closed fracture group. The open fracture group had more infections (37.5% vs. 5.7%, P<0.001) and longer stays in the intensive care unit (median 11 days, interquartile range [IQR] 6-30 days vs. median 5 days, IQR 2-13 days; P=0.005), but mortality did not show a statistically significant difference (20.8% vs. 15.5%, P=0.559) before matching. After 1:2 propensity score matching, the infection rate was significantly higher in the open fracture group (37.5% vs. 6.3%, P=0.002), whereas the length of intensive care unit stay (median 11 days, IQR 6-30 days vs. median 8 days, IQR 4-19 days; P=0.312) and mortality (20.8% vs. 27.1%, P=0.564) were not significantly different. Conclusions: The open pelvic fracture group had more infections than the closed pelvic fracture group, but mortality was not significantly different. Aggressive treatment of pelvic bone fractures is important regardless of the fracture type, and efforts to reduce infection are important in open pelvic bone fractures.

• Journal of Trauma and Injury
• /
• 제28권3호
• /
• pp.144-148
• /
• 2015

Purpose: Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn't an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. Methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. Results: The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. Conclusion: Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies.

• Journal of Trauma and Injury
• /
• 제31권2호
• /
• pp.72-75
• /
• 2018

Acetabular and Pelvic ring fractures are major high-energy trauma injuries and are often combined with other injuries. In particular, cause of long duration of immobilization and combined injuries, venous thromboembolism is a common complication in trauma patients with pelvic or acetabular fractures. We report a case of a fatal pulmonary thromboembolism during the acetabulum fracture operation in a 62-year-old male patient.

• Journal of Trauma and Injury
• /
• 제29권4호
• /
• pp.201-203
• /
• 2016

Rectal injury is seen in 1-2% of all pelvic fractures, and lower urinary tract injury occurs in up to 7%. These injuries are rare, but if missed, can lead to a severe septic response. Rectal injury may be suspected by the presence of gross blood on digital rectal examination. However, this classic sign is not always present on physical examination. If an Antero-Posterior Compression type pelvic fracture is seen, we should consider the possibility of rectal and lower urinary tract injury. It is important to define the anatomic location of the rectal injury as it relates to the peritoneal reflection. Trauma to the intraperitoneal rectum should be managed as a colonic injury. Extraperitoneal rectal injury should be managed with fecal diversion regardless of primary repair. We present the case of a 46-year-old man who was referred to our hospital following a major trauma to the pelvis in a pedestrian accident.